The "Are You Older Than Dirt?: Part I - Cancer Screening" Story

It was an ordinary day.  Just left my urologist's office with some disturbing news.  A little over 6 months ago, at the age of 72, I had Cryosurgery to remove the prostate cancer that I had.  In my follow up visit a few months later I found that my PSA (prostate specific antigen or the guide that physicians use to predict prostate cancer) was 0.01.  Near perfect!  My follow up today wasn't what I was hoping for, since my PSA had risen to 0.09.  My urologist felt it was elevated beyond what it should be for so close to the surgery.  I must have blood drawn once again in 2 months to see if it is still elevated.  A digital exam did show that my prostate is the size of 20 year old, but he was still cautious and thus a new test.  Had I been 75 years old I may not have been able to have the test according to several medical groups that believe that the benefits are overshadowed by the harm the test and followup procedures that may be done could causse.  Seems the general rule is that if you have an incurable disease and will die within the next 10 years, there is no need to be tested for prostate cancer.  Perhaps since I have found that I already had prostate cancer, the rules may be changed so I can continue to be tested to make sure it doesn't return.  After all, the test is no more than a simple blood test!  Same thing goes for women and breast cancer.  If you might be in your 80s and perhaps suffer from dementia, should you continue to be tested for breast cancer?  And, if they find you have breast cancer, is it worthwhile to treat it with an invasive operation.  Will the cost of the procedure allow you to live past the time you have left due to the dementia?  And, just who should make the decision about your having these tests.  As someone said to me, those that make these decisions must be part of a "Death Watch."  My urologist told me that 70% of men in their 70s will more than likely have prostate cancer.  Should he recommend that his older patients, say in their 80s, have the PSA test done to see if they may have prostate cancer when they more than likely have the disease, but will die from something else rather than prostate cancer.  So, what should and can be done to determine the advantages vs. the disadvantages of cancer screening?  My guest is the biggest determining factor will be the cost.  The PSA test is very inexpensive, but if you add on the cost of more testing and then surgery and follow up visits, the cost is very high.  Prostate cancer screening in men over 75 costs Medicare at least $145 million a year with no estimate on costs that may follow.  Mammograms in this same age group cost Medicare more that $410 million a year.  Growing old isn't cheap!  But, I paid into the Medicare program for many, many years and if that were invested wisely, it should easily pay for those tests and following care.  And, who should be the one to tell someone who has been told that starting in your 40s you should begin to be tested for certain diseases and all of a sudden, when they reach 75, you may no longer be tested, since your life is no longer important to the medical world.  Well, I guess I'm lucky I'm not 75 yet or maybe my Medicare wouldn't pay for my tests.  That is unless my government starts to change the rules on me.  It was another extraordinary day in the life of an ordinary guy.